How to provide a urine sample and avoid unnecessary antibiotics

Earlier this year I wrote a post on having had several urinary tract infections in the summer. With another summer on the way I’m keen to avoid a repeat, so this month I sat down with an infectious diseases specialist who’s adamant that too many of us are being misdiagnosed with UTIs. Here’s what I learnt.

Amazingly, we’re never taught to provide a urine sample properly.

Bacteria such as E. coli are naturally found in our intestines, and it’s normal that we have some of it on our skin.

When we’re in a toilet cubicle trying to direct a mid-stream flow into jar not much bigger than an egg cup, it’s inevitable that the urine touches our skin and picks up bacteria en route to the jar.

When we then get a pathology report which says we have bacteria in our specimen, the GP pronounces we have a UTI and we’re prescribed antibiotics.

The specialist says it’s his lifelong ambition to interrupt this process because it’s doubly flawed: after we provide a contaminated sample, GPs misinterpret the pathology report.

GPs see only that there were bacteria in the sample. But he read over my reports and pointed out that although bacteria were present, on each one the white cell count was too low to indicate a UTI.

So first things first, how do we provide an uncontaminated sample?

We need to turn and face the cistern so we have more room over the bowl, and with the hand that’s not holding the jar, part our vaginal lips so the urine can flow straight into the jar without running over our skin and collecting bacteria.

He assured me that in providing a mid-stream flow we’ll most likely pee on our hand, so be prepared for it to be messy work.

We concluded that I probably hadn't had UTIs, and it was more likely bacterial vaginosis, where the bacterial composition in the vagina becomes unbalanced, possibly because I got out of step in using estrogen pessaries.

As a result, I probably also took four lots of antibiotics I didn't need.

The other important point to make about UTIs is that the conventional wisdom about drinking more water to flush out bacteria has been backed by research.

A recent study from the University of Miami showed that UTI-prone women who drank an extra 1.5 litres of water a day halved their rates of infection.

The specialist says he asks patients what colour urine is, and when they reply that it’s yellow, he reminds them that it’s meant to be clear.